Several rural Nova Scotia hospitals operate as Collaborative Emergency Centers (CEC) in the evenings when the attending physician is off-duty. This model is a pioneer in Canadian health care.

The staff consists of a paramedic and nurse working as a patient centred team to assess and treat patients without a physician on-site. The paramedic and nurse consult with an emergency physician over the phone for each patient, and the three disciplines work together to develop a care plan for the patient. This care plan might involve treating the patient that night and then have the patient come back the next day to follow-up with a doctor.

If the patient needs urgent care that cannot be provided at the CEC, the patient can be transferred by ambulance to the closest regional facility. A paramedic working in a CEC may be a Primary Care Paramedic, Intermediate Care Paramedic, or Advanced Care Paramedic.